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1. 发明授权

US09713701B2 Using multiple diagnostic parameters for predicting heart failure events 有权
公开(公告)号：US09713701B2
公开(公告)日：2017-07-25
申请号：US12184003
申请日：2008-07-31
申请人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
发明人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
IPC分类号： A61N1/365 , A61M37/00 , A61B5/046 , A61B5/0464 , A61B5/053 , A61B5/11
CPC分类号： A61B5/0422 , A61B5/0205 , A61B5/021 , A61B5/046 , A61B5/0464 , A61B5/0537 , A61B5/0538 , A61B5/08 , A61B5/1118 , A61B2562/0219 , A61M5/1723 , A61M37/00 , A61M2230/04 , A61M2230/42 , A61N1/36585
摘要： Techniques for using multiple physiological parameters to provide an early warning for worsening heart failure are described. A medical device monitors a primary diagnostic parameter that is indicative of worsening heart failure, such as intrathoracic impedance or pressure, and one or more secondary diagnostic parameters. The medical device detects worsening heart failure in the patient based on the primary diagnostic parameter when an index that is changed over time based on the primary diagnostic parameter value is outside a range of values, termed the threshold zone. When the index is within the threshold zone, the medical device detects worsening heart failure in the patient based on the one or more secondary diagnostic parameters. Upon detecting worsening heart failure, the medical device may, for example, provide an alert that enables the patient to seek medical attention before experiencing a heart failure event.

2. 发明授权

US08255046B2 Detecting worsening heart failure based on impedance measurements 有权
标题翻译：基于阻抗测量检测恶化的心力衰竭
公开(公告)号：US08255046B2
公开(公告)日：2012-08-28
申请号：US12184149
申请日：2008-07-31
申请人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
发明人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
IPC分类号： A61B5/05
CPC分类号： A61B5/053 , A61B5/0031 , A61B5/6846 , A61N1/3627 , A61N1/36521 , A61N1/37235 , A61N1/37258 , A61N1/3962
摘要： Techniques for processing impedance data to provide an early warning for heart failure decompensation are described. An example device may be configured to measure intrathoracic impedance values, and increment an index when a determined impedance is less than a reference impedance. The incrementing may be based on the difference between the reference impedances and the determined impedance. In some examples, the amount of incrementing is reduced based on a variability of the impedances, or increased over time so long as the index remains above a threshold, e.g., zero. In some examples, the manner is which the reference impedances are determined changes over time to, for example, address rapid changes in impedance after device or system implantation. In some examples, the index is compared to a threshold to determine whether to provide an alert. In some examples, two thresholds are used to provide hysteresis.
摘要翻译：描述了用于处理阻抗数据以提供心力衰竭失代偿的早期警告的技术。示例性装置可以被配置为测量胸内阻抗值，并且当确定的阻抗小于参考阻抗时增加指数。增量可以基于参考阻抗和确定的阻抗之间的差异。在一些示例中，只要索引保持高于阈值（例如零），基于阻抗的可变性减小增量的量，或随时间增加。在一些示例中，确定参考阻抗的方式随着时间而变化，例如，在器件或系统植入之后阻抗的快速变化。在一些示例中，将索引与阈值进行比较，以确定是否提供警报。在一些示例中，使用两个阈值来提供滞后。

3. 发明申请

US20100030293A1 USING MULTIPLE DIAGNOSTIC PARAMETERS FOR PREDICTING HEART FAILURE EVENTS 有权
标题翻译：使用多种诊断参数预测心脏衰竭事件
公开(公告)号：US20100030293A1
公开(公告)日：2010-02-04
申请号：US12184003
申请日：2008-07-31
申请人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
发明人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
IPC分类号： A61N1/365 , A61B5/00 , A61M37/00
CPC分类号： A61B5/0422 , A61B5/0205 , A61B5/021 , A61B5/046 , A61B5/0464 , A61B5/0537 , A61B5/0538 , A61B5/08 , A61B5/1118 , A61B2562/0219 , A61M5/1723 , A61M37/00 , A61M2230/04 , A61M2230/42 , A61N1/36585
摘要： Techniques for using multiple physiological parameters to provide an early warning for worsening heart failure are described. A medical device monitors a primary diagnostic parameter that is indicative of worsening heart failure, such as intrathoracic impedance or pressure, and one or more secondary diagnostic parameters. The medical device detects worsening heart failure in the patient based on the primary diagnostic parameter when an index that is changed over time based on the primary diagnostic parameter value is outside a range of values, termed the threshold zone. When the index is within the threshold zone, the medical device detects worsening heart failure in the patient based on the one or more secondary diagnostic parameters. Upon detecting worsening heart failure, the medical device may, for example, provide an alert that enables the patient to seek medical attention before experiencing a heart failure event.
摘要翻译：描述了使用多种生理参数为恶化心力衰竭提供早期预警的技术。医疗设备监测指示心脏衰竭恶化的主要诊断参数，例如胸内阻抗或压力，以及一个或多个次要诊断参数。当基于主要诊断参数值随时间改变的索引在称为阈值区域的值的范围之外时，医疗装置基于主要诊断参数来检测患者的心脏衰竭的恶化。当索引在阈值区域内时，医疗装置基于一个或多个次要诊断参数来检测患者心脏衰竭的恶化。在检测到心脏衰竭恶化时，医疗装置可以例如提供使患者能够在经历心力衰竭事件之前寻求医疗护理的警报。

4. 发明申请

US20100030292A1 DETECTING WORSENING HEART FAILURE BASED ON IMPEDANCE MEASUREMENTS 有权
标题翻译：基于阻抗测量检测心脏衰竭的心脏衰竭
公开(公告)号：US20100030292A1
公开(公告)日：2010-02-04
申请号：US12184149
申请日：2008-07-31
申请人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
发明人： Shantanu Sarkar , Douglas A. Hettrick , Robert W. Stadler
IPC分类号： A61N1/39 , A61B5/053 , A61N1/365
CPC分类号： A61B5/053 , A61B5/0031 , A61B5/6846 , A61N1/3627 , A61N1/36521 , A61N1/37235 , A61N1/37258 , A61N1/3962
摘要： Techniques for processing impedance data to provide an early warning for heart failure decompensation are described. An example device may be configured to measure intrathoracic impedance values, and increment an index when a determined impedance is less than a reference impedance. The incrementing may be based on the difference between the reference impedances and the determined impedance. In some examples, the amount of incrementing is reduced based on a variability of the impedances, or increased over time so long as the index remains above a threshold, e.g., zero. In some examples, the manner is which the reference impedances are determined changes over time to, for example, address rapid changes in impedance after device or system implantation. In some examples, the index is compared to a threshold to determine whether to provide an alert. In some examples, two thresholds are used to provide hysteresis.
摘要翻译：描述了用于处理阻抗数据以提供心力衰竭失代偿的早期警告的技术。示例性装置可以被配置为测量胸内阻抗值，并且当确定的阻抗小于参考阻抗时增加指数。增量可以基于参考阻抗和确定的阻抗之间的差异。在一些示例中，只要索引保持高于阈值（例如零），基于阻抗的可变性减小增量的量，或随时间增加。在一些示例中，确定参考阻抗的方式随时间而变化，例如，在器件或系统植入之后，阻抗的快速变化。在一些示例中，将索引与阈值进行比较，以确定是否提供警报。在一些示例中，使用两个阈值来提供滞后。

5. 发明申请

US20120109245A1 CARDIAC THERAPY BASED UPON IMPEDANCE SIGNALS 有权
标题翻译：基于阻抗信号的心脏病治疗
公开(公告)号：US20120109245A1
公开(公告)日：2012-05-03
申请号：US12916012
申请日：2010-10-29
申请人： Douglas A. Hettrick , Todd M. Zielinski , Eduardo Warman , Shantanu Sarkar
发明人： Douglas A. Hettrick , Todd M. Zielinski , Eduardo Warman , Shantanu Sarkar
IPC分类号： A61N1/365
CPC分类号： A61N1/36521 , A61B5/0452 , A61B5/0535 , A61B5/7239 , A61N1/3627 , A61N1/3682 , A61N1/3684 , A61N1/3987
摘要： Methods and/or devices are disclosed herein for monitoring cardiac impedance signal and delivering therapy to a patient's heart based upon the monitored cardiac impedance.
摘要翻译：本文公开了用于监测心脏阻抗信号并基于所监测的心脏阻抗将治疗递送到患者心脏的方法和/或装置。

6. 发明申请

US20080103530A1 Methods and Apparatus for Manually Suspending Intrathoracic Impedance Fluid Status Measurements 有权
标题翻译：手动悬挂胸膜内阻抗液体状态测量的方法和装置
公开(公告)号：US20080103530A1
公开(公告)日：2008-05-01
申请号：US11554825
申请日：2006-10-31
申请人： Holly S. Vitense , Li Wang , Denise Dirnberger , Melissa M. Rhodes , Douglas A. Hettrick , Shantanu Sarkar
发明人： Holly S. Vitense , Li Wang , Denise Dirnberger , Melissa M. Rhodes , Douglas A. Hettrick , Shantanu Sarkar
IPC分类号： A61N1/00
CPC分类号： A61N1/37258 , A61B5/0031 , A61B5/0215 , A61B5/053 , A61N1/37247 , G16H40/63
摘要： The capability to suspend a patient alert relating to a monitored physiologic parameters addresses a need to selectively shut off a patient-alert signal or signals during the time a patient is being treated for an excursion in the parameter. Of course, in general a signal call attention to a patient's a potentially deleterious status or condition for which they should seek medical attention. Once a chronically-implanted monitoring device has detected or provided information about the parameter relative to a desired value, trend, or range and a clinician has been notified and intervened the alert signal is temporarily disabled for a predetermined period. That is, once the notification occurs and alert has served its purpose, the alert mechanism is selectively deactivated while the patient ostensibly begins to gradually correct the monitored physiologic parameter under a caregiver's direction and control. After which time, the alert will reactivate.
摘要翻译：暂停与所监测的生理参数相关的患者警报的能力解决了在患者被治疗参数期间偏移的时间期间选择性地切断病人警报信号或信号的需要。当然，一般来说，一个信号会引起对患者的一个潜在的有害的状态或状况的关注，他们应该寻求医疗护理。一旦长期植入的监测装置已经相对于期望值，趋势或范围已经检测或提供了关于参数的信息，并且已通知临床医生并且中介了警报信号暂时禁用预定时间段。也就是说，一旦通知发生并且警报已经达到其目的，则警告机制被选择性地去激活，同时患者表面上开始逐渐校正受照顾者的方向和控制下的监测的生理参数。之后，警报将重新启动。

7. 发明授权

US08435186B2 Quantifying autonomic tone with thoracic impedance 有权
标题翻译：量化自主神经与胸阻抗
公开(公告)号：US08435186B2
公开(公告)日：2013-05-07
申请号：US12696753
申请日：2010-01-29
申请人： Douglas A. Hettrick , Donald J. Hefner , Shantanu Sarkar , Todd M. Zielinski
发明人： Douglas A. Hettrick , Donald J. Hefner , Shantanu Sarkar , Todd M. Zielinski
IPC分类号： A61B5/00
CPC分类号： A61N1/36521 , A61B5/0031 , A61B5/0215 , A61B5/02405 , A61B5/053 , A61B5/08 , A61B5/11 , A61B5/1116 , A61B5/4035 , A61N1/36535 , A61N1/37247 , A61N1/37258
摘要： The disclosure describes techniques for quantifying the autonomic nervous system (ANS) health of a patient with thoracic impedance measurements. Thoracic impedance may be measured utilizing cardiac electrodes and an implantable medical device housing or other electrodes located on or within the patient. Since greater variability in thoracic impedance may indicate better health of the ANS, monitoring impedance changes in a patient may be used to quantify autonomic tone of the ANS, and ultimately, overall patient health. In some examples, thoracic impedance may be measured in response to a change in patient posture for acute monitoring or at predetermined times over several days, weeks, or months for more chronic monitoring of the patient. An implantable medical device may independently analyze the impedance measurements and transmit an alert to the patient or clinician when impedance changes indicate a change in patient health.
摘要翻译：本公开描述了用于量化具有胸部阻抗测量的患者的自主神经系统（ANS）健康的技术。可以使用心电极和位于患者内部或内部的可植入医疗装置外壳或其它电极来测量胸腔阻抗。由于胸部阻抗变化较大可能表明ANS的健康状况良好，所以监测患者的阻抗变化可用于量化ANS的自主音调，并最终对整体患者的健康状况进行量化。在一些示例中，可以响应于用于急性监测的患者姿势的变化或在几天，几周或几个月的预定时间来测量胸部阻抗以进行更长期的患者监测。当阻抗变化表示患者健康状况发生变化时，植入式医疗设备可以独立地分析阻抗测量结果并向患者或临床医生发送警报。

8. 发明申请

US20120303085A1 METHODS AND APAPRATUS FOR MANUALLY SUSPENDING INTRATHORACIC IMPEDANCE FLUID STATUS MEASUREMENTS 审中-公开
标题翻译：用于手动停止静脉内阻滞流体状态测量的方法和APAPRATUS
公开(公告)号：US20120303085A1
公开(公告)日：2012-11-29
申请号：US13570858
申请日：2012-08-09
申请人： Holly S. Vitense , Li Wang , Denise Dirnberger , Melissa M. Rhodes , Douglas A. Hettrick , Shantanu Sarkar
发明人： Holly S. Vitense , Li Wang , Denise Dirnberger , Melissa M. Rhodes , Douglas A. Hettrick , Shantanu Sarkar
IPC分类号： A61N1/365
CPC分类号： A61N1/37258 , A61B5/0031 , A61B5/0215 , A61B5/053 , A61N1/37247 , G16H40/63
摘要： The capability to suspend a patient alert relating to a monitored physiologic parameters addresses a need to selectively shut off a patient-alert signal or signals during the time a patient is being treated for an excursion in the parameter. Of course, in general a signal call attention to a patient's a potentially deleterious status or condition for which they should seek medical attention. Once a chronically-implanted monitoring device has detected or provided information about the parameter relative to a desired value, trend, or range and a clinician has been notified and intervened the alert signal is temporarily disabled for a predetermined period. That is, once the notification occurs and alert has served its purpose, the alert mechanism is selectively deactivated while the patient ostensibly begins to gradually correct the monitored physiologic parameter under a caregiver's direction and control. After which time, the alert will reactivate.
摘要翻译：暂停与所监测的生理参数相关的患者警报的能力解决了在患者被治疗参数期间偏移的时间期间选择性地切断病人警报信号或信号的需要。当然，一般来说，一个信号会引起对患者的一个潜在的有害的状态或状况的关注，他们应该寻求医疗护理。一旦长期植入的监测装置已经相对于期望值，趋势或范围已经检测或提供了关于参数的信息，并且已通知临床医生并且中介了警报信号暂时禁用预定时间段。也就是说，一旦通知发生并且警报已经达到其目的，则警告机制被选择性地去激活，同时患者表面上开始逐渐校正受照顾者的方向和控制下的监测的生理参数。之后，警报将重新启动。

9. 发明申请

US20120253207A1 HEART FAILURE MONITORING 审中-公开
标题翻译：心力衰竭监测
公开(公告)号：US20120253207A1
公开(公告)日：2012-10-04
申请号：US13436408
申请日：2012-03-30
申请人： Shantanu Sarkar , Jodi L. Redemske , Eduardo N. Warman , Douglas A. Hettrick , Kevin T. Ousdigian
发明人： Shantanu Sarkar , Jodi L. Redemske , Eduardo N. Warman , Douglas A. Hettrick , Kevin T. Ousdigian
IPC分类号： A61B5/0205
CPC分类号： A61B5/0006 , A61B5/0004 , A61B5/7275 , G06F19/3418 , G16H40/40 , G16H50/30
摘要： Techniques for transmitting diagnostic information stored in an implantable medical device (IMD) based on patient hospitalization are described. For example, the IMD may transmit higher resolution diagnostic information to a clinician and/or an external device during a hospitalization period to aid the clinician in evaluating heart failure treatment and when discharge is proper. This higher resolution diagnostic information may include one or more patient metrics automatically generated and transmitted by the IMD at least once every two hours. During a post-hospitalization period, the IMD may transmit lower resolution diagnostic information to a clinician that indicates a risk level of re-hospitalization. The lower resolution diagnostic information may include the risk level and/or patient metrics once a day, for example. In this manner, the IMD transmitted diagnostic information may be tailored to the specific heart failure monitoring needed by the patient.
摘要翻译：描述了基于患者住院时间传送存储在可植入医疗装置（IMD）中的诊断信息的技术。例如，IMD可以在住院期间向临床医师和/或外部设备传送更高分辨率的诊断信息，以帮助临床医师评价心力衰竭治疗以及放电是否合适。该更高分辨率的诊断信息可以包括由IMD自动生成和发送的至少每两小时一次的一个或多个患者度量。在住院后期间，IMD可以向临床医生传递较低分辨率的诊断信息，指示重新住院的风险水平。例如，较低分辨率诊断信息可以包括一天一次的风险水平和/或患者度量。以这种方式，IMD传输的诊断信息可以针对患者所需的特定心力衰竭监测。

10. 发明申请

US20100113962A1 SYSTEM AND METHOD TO LOCALIZE CHANGES IN INTRATHORACIC FLUID CONTENT USING MEASURED IMPEDANCE IN AN IMPLANTABLE DEVICE 有权
标题翻译：使用可植入装置中的测量阻抗来定位变化的流体内容物的系统和方法
公开(公告)号：US20100113962A1
公开(公告)日：2010-05-06
申请号：US12261131
申请日：2008-10-30
申请人： Douglas A. Hettrick , Shantanu Sarkar , Todd M. Zielinksi , Kevin P. Knox
发明人： Douglas A. Hettrick , Shantanu Sarkar , Todd M. Zielinksi , Kevin P. Knox
IPC分类号： A61B5/053
CPC分类号： A61B5/0536 , A61B5/0537 , A61B5/0538 , A61B5/4878
摘要： An implantable medical device and associated methods monitor thoracic fluid status and discriminate thoracic fluid conditions. Intrathoracic impedance is measured along multiple intrathoracic measurement vectors using implanted electrodes. A map of thoracic conductivity is computed using the measured intrathoracic impedances. A thoracic fluid condition is detected in response to the computed map.
摘要翻译：可植入医疗器械和相关方法监测胸腔液状态并辨别胸腔液体状况。使用植入电极沿多个胸腔内测量载体测量胸内阻抗。使用测量的胸腔内阻抗计算胸导电图。根据计算的图检测胸部液体状况。

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